Challenges in using central venous access devices outside of ICU settings in pediatrics

Reliable and long-lasting venous access in children is preferred outside the ICU settings where CVADs are essential for long-term treatment involving administration of long-term nutrition in gut enteropathies, chemotherapy, hemodialysis as well as in palliative situations requiring pain medications or administration of antibiotics as in chronic osteomyelitis. Alina Burek et al. have brought to light important aspects related to the use of CVADs outside the ICU settings. The authors found distinct benefits to healthcare facilities that have vascular access teams as they follow established guidelines for the use of CVADs. A dedicated specialized team with good knowledge of devices helped in the choice of appropriate CVAD and optimal CVAD utilization. It is important to follow the key principles when using CVADs. This includes the choice of appropriate devices depending on the duration of use. CVADs with the smallest outer diameter and least number of lumens should be chosen where the catheter outer diameter should be less than 45% of that of the vein to reduce risk of thrombosis. Infection prevention protocol must be strictly implemented and the CVAD promptly removed when no longer required. CVAD performance is often taken as a benchmark of hospital performance, highlighting its importance.